Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

12th World AIDS Conference

Abstracts 60241-60246 1043

60241 HIV treatment planning workshop
Michael Immel. AIDS Action Committee, 131 Clarendon Street Boston MA
02116, USA
People with HIV need hands-on, practical, peer-led skill-building to make full use
of the services available from the medical community and AIDS service organizations. Through a structured discussion of treatment issues, the Workshop
provides support in helping people with HIV manage their health. The Workshop
seeks to teach a simple yet comprehensive model of HIV treatment that patients
adapt to their own particular needs. The model is graphic and easily understood
viually. The Workshop can be readily modified to be appropriate for diverse
cultural groups by changing words, emphasis, and social issues.
A typical workshop will begin by introducing the model followed by a group
discussion of the components. Participants then write, list, or draw their treatment
histories and plan for action on large flip chart paper taped to the walls; participants then present their histories to the group with discussion. The session ends
with a discussion of available sources of treatment information and resources.
Through their participation in the Workshop, PWAs articulate to themselves
and to others what they are actually doing medically and what they plan for
the future. The writing and presenting required during the Workshop stimulates
self-assessment and helps clarify treatment goals. Workshop graphic is widely
and easily understood.
60242 Clinical trilas review
Michael Immel. AIDS Action Committee, 131 Clarendon Street Boston MA
02116, USA
People with HIV are confronted with an array of clinical trials for the treatment
of HIV disease; the Clinical Trial Reviews seek to create a "consumer report" on
these trials and evaluate clinical research from the point of view of an HIV-positive
person who is considering entering a trial. The Reviews seek to guide potential
participants through the maze of clinical research by presenting information that
fits their needs and interests.
Of the various parties involved in clinical trial investigations-including pharmaceutical developers, researchers, government regulators only participants are left
without a voice. The Reviews aim to provide such a voice and enter into dialogue
with the other parties. Volunteer writers read and discuss protocols and the reviews are revised and then draft reviews are sent to researchers for comment,
published and distributed throughout Massachusetts. As a result of our Reviews
some researchers have changed elements of the trial protocol to improve trial
design and increase opportunities for enrollment.
The Reviews has been published three times in collaboration with ACT UP
Boston, and volunteers in the HIV Treatment Information and Education Program
in Boston.
The Reviews have actively brought a consumer's point of view to the HIV
research community in Boston. This process occasionally led to changes in trial
design. Anecdotal responses from people with HIV, researchers, physicians, and
other providers generally report favorably.
60243 Pattern of sexually transmitted diseases at a referral
center of Karachi
Rafiq Muhammad', Muneer Soomro2, S.A. Mujeeb3, Jamil Agha4,
Muhammad Shoaib5. 196-Bantva Nagar Liaqatabad Karachi 175900; 2Civil
Hospital Karachi, Karachi; 3JMPC, Karachi; 4AGA Khan University Hospital,
Karachi; 5AIDS Prevention Society, Karachi, Pakistan
Objective: To find out prevalence of STDs in a tertiary care facility in Karachi.
Design: Prospective, epidemiological.
Methods: Cases referred to a tertiary care facility for STDs during the month of
August 1997 were included in the study after obtaining informed consent. Clinical
history and physical examination was performed and blood was tested for RPR,
Hepatitis B Surface Antigen (HBsAg), anti HBcore and HIV.
Results: Out of 220 cases of STDs enrolled, RPR was reactive in 44%, HBc
antibody in 23% and HBsAg in 10%. HIV antibody was detected in only one case
(0.45%).
Discussion: Syphilis and hepatitis B were most common STDs at the referral
center. HIV is only recently reported in this group and its incidence appears
low. Other STDs such as gonorrhea, chancroid and warts are generally dealt at
primary health care facilities and are therefore, seen less frequently at tertiary
level.
Conclusion: Due to late introduction and low incidence of HIV it is appropriate
time to utilize all the available resources for prevention of a full scale HIV epidemic
in sexually active population.
60244 Work Practices Manual - Essential in the prevention of
transmission of HIV, H and HC in the clinical setting

Ross Philpot1, J.A. Goode2, E. Coates3, V. Letford4. 1SA Infectious Diseases
Services, Adelaide, SA; 2Australian institute of Dental Assistants, Adelaide, SA;
3South Australian Dental School, Adelaide, SA; 4Manager CSSD Queen
Elizabeth Hospital, Adelaide, SA, Australia
Issue: National and International "What to do" policies for the prevention of transmission of blood borne disease must be converted into "How to do it" protocols
for use in real life health care settings.

Project: The AIDA (Australian Institute of Dental Assistants (SA) Inc.) has done
this by compiling a Work Practices Manual which is adaptable for all medical,
dental and allied health care settings.
Results: The manual comprises of X-sections including
(1) Standard Precautions, Vaccinations
(2) Post in Dental procedures
(3) Waste Disposal
(4) Protocols Specific to Specialist practices
(5) Decontamination, Packaging, Sterilisation and Storage of instruments
These sections are easily interchangeable to suit the type of practice.
Lessons Learned: A well developed work practices manual greatly facilitates
the introduction and continuance of a safe work practice and environment for the
delivery of health care. The Practice Manual assists in the development of a team
approach to patient care and streamlines health services.
60245 Is Confucius to blame? - HIV/AIDS and women in
Vietnam
Paula-Frances Kelly. CARE International in Vietnam, Ho Chi Minh City; 91/35 Su
Van Hanh Noi Dai Q10, Ho Chi Minh City, Vietnam
Issue: Why, in a centralist governmental system where people believe and have
respect for government messages, is HIV/AIDS spreading? Projects to impact
on the AIDS pandemic in Vietnam have largely failed, regardless of government
instigated advances in education, economics, and technology.
Project: Starting from the Vietnamese concept of "traditional family" as the
safeguard against HIV/AIDS, research has been carried out into the meaning
of this concept in the peace times of the late 1990s via qualitative methods,
document analysis and trailling of pilot projects of an action research nature.
Results: The Confucian philosophy is still extremely strong in the family leaving
finite gender roles the cultural norm. These roles accept sexual freedom for men
as a right and not for women and women agree with this. Even with a concerted
effort by the government at gender equality in institutions, government and the
law, women at large remain in the Confucian world in their own families - expected
to please men without question and to raise their children. The "traditional family"
of Vietnam appears to be as proscribed by Confucius. It works against HIV
prevention, it is feudal, male dominated, unequal, set in stone, elitist. Roles in the
family have hardly changed regardless of economic advances. The internationally
developed indicators of women's levels of vulnerability to HIV infection are all
present in the Vietnamese community today: women's economic dependency
on men, ignorance about sex, sexuality and safety, confined or controlled social
networks, unreal social expectations of being a wife/mother, double standards for
men. Women lack the preconditions which empower them to keep safe.
Lessons Learned: To halt the spread of the virus, programmes for the development of new relationships between men and women must be put in place.
Vietnamese "traditional family" values need rethinking in the era of AIDS.
60246 Characterizing an epidemic: 10 years of patient
attendance at a South African HIV clinic
Andrew Kanter 2, G.B.T. Pham-Kanter3, D.C. Spencer4. M.H. Steinberg5. '2657
1N. Mildred Ave #2, Chicago, IL 60614-2318, USA; 2 Wolfson College,
Cambridge University, Cambridge; 3Trinity College, Cambridge University
Cambridge, UK; University of Witwatersand, Johannesburg: 5HIV Management
Services, Johannesburg, South Africa
Background: South Africa has experienced a dramatic rise in the number of
patients infected with HIV. Currently, attention has been focused on shifting care
of HIV-infected patients to the outpatient setting, but questions about patient care
and efficient use of limited resources remain. Using an observational database
from the Johannesburg General Hospital HIV Clinic, we have described the
changes in HIV clinic attendance over a ten year period by disease severity and
patient demographics. We have also characterized the relationship between clinic
attendance (visit frequency) and health and demographic factors.
Methods: Patient data from a retrospective, longitudinal, computerized observational database of comprehensive clinical records of -2100 patients, seen
between 1985 and 1995, were used. Automated disease staging was performed
at each visit. For the analysis, cross-tabulations were performed, and a Poisson
regression was used to identify determinants of visit frequency.
Results: Initial visits by white, male, homosexual patients plateaued around
50-100/year in 1989, while visits from heterosexual black patients has been
rising exponentially since 1989. In 1993, the number of new women attending
the clinic exceeded the number of men. The ratio of asymptomatic visits to AIDS
visits has remained constant (2:1) throughout the epidemic. The predictors of visit
frequency were CD4 count and the number of new opportunistic infections and
secondary indicators (p < 0.01). There was a weak negative association between
visit frequency and the use of personal funds for medical care (p - 0.05). Gender
and race/ethnicity were not associated with the number of visits.
Conclusions: 1) Women and black patients make up the largest and fastest
growing patient population, and therefore, special attention should be placed on

their care. 2) Two-thirds of all patients seen in the clinic are asymptomatic and
could be cared for in a less-intensive environment. 3) Severity of illness and
economic resources are important determinants of clinic visits, but demographic
factors such as race and gender are not.